Developmental Screening Quiz

While A & C are necessary and critical components, the most successful way to ensure early detection of developmental problems from birth through age 5 is through periodic developmental-behavioral screening using a formal measure or procedure.

At the heart of all early detection systems is the actual process of developmental-behavioral screening.

Developmental-behavioral screening is defined as a brief, easy-to-complete formal test of young children's developmental skills that reliably discriminate those children who should be referred for further, more comprehensive assessment from those who should not be referred.

Developmental-behavioral screening results should yield one of three outcomes: The child's developmental status appears to be 1) typical, 2) borderline, or 3) in need of further assessment based on his or her performance score.

If a child's score is in the typical range, then the screener informs the parent that the child's performance is what one would expect from other children in the same age. If a child's score falls into the borderline range of one or more developmental-behavioral areas, the screener informs the parent and recommends a follow-up screening. If a child's score is in the needs further assessment range, then the screener recommends more comprehensive assessments to determine what type of services may be appropriate for the child and family.

There is a need for universal and periodic early identification of all young children between birth and age 5 because children's development is dynamic and problems can arise at any time during the early years.

Without periodic developmental-behavioral screening of children, timely identification is not possible and problems may evolve into more serious threats to well-being.

In the context of developmental-behavioral screening, monitoring (tracking or follow-along) refers to the process of periodically checking a child's developmental-behavioral status over time. Medical personnel often use the word surveillance; however, many education, social services, and developmental specialists are unfamiliar with its use in the context of screening.

The purpose of monitoring/tracking is to ensure that children continue to thrive and meet developmental-behavioral expectations for their chronological age.

In the case of screening, referral refers to the concrete action that screening personnel take to get families connected to the next appropriate service. In most cases, it is focused on assisting parents or caregivers in arranging for a more comprehensive assessment of their child to determine if intervention services are in order.

The purpose of referral is to ensure that children and families are connected to an appropriate agency that can provide a comprehensive evaluation.

In the United States, historical as well as contemporary research consistently suggests that approximately 15%-17% of children from birth to 21 years are diagnosed with a developmental-behavioral disorder or disability.

Here are some of the more commonly occurring conditions and their prevalence:

• social-emotional/behavioral disorders: 21%
• speech & language impairment: 13.5% (expressive speech delays, 18-23 months); 17.5% (expressive speech delays, 30-36 months); 7.4% (language impairment, 3-17 years)
• ADHD: 7.6% (3-17 years)
• learning disability: 7.2% (3-17 years)
• developmental coordination disorder: 1.7%-6% (5-11 years)
• intellectual disability: 0.67%-1.2% (3-17 years)
• autism spectrum disorder: 0.74%-1.1% (3-17 years)

The economic benefits of early intervention services have been examined. Estimates range from $4 to $17 returned for every dollar spent on such programs, in terms of greater earning power, improved mental health status, and job productivity.

If every child living in poverty received 2 years of quality early childhood education, this investment, it has been estimated, would yield a 16% annual return rate in cost savings through the effects listed.

The American Academy of Pediatrics (AAP) recommends that all children receive early identification services, including surveillance and screening, and if needed, developmental or medical diagnostic evaluation.

The AAP recommends screening at 9, 18, 24, and 30 months, and children should be screened whenever a clinician's surveillance "demonstrates risk."

Despite this recommendation, most pediatric or other health care practices do not routinely screen their young patients or consistently refer children identified by a screening test for follow-up assessment to determine their eligibility for services.

Although all these choices may represent barriers, there are 3 major barriers to the creation and operation of a comprehensive, integrated, community-based early detection program:

• the lack of coordinated services
• accessibility, and
• necessary resources to establish and maintain effective systems.

When early detection efforts are not coordinated at the local, regional, or state level, limited resources and time may be used ineffectively and inefficiently by personnel implementing programs. Access is challenging for many families, particularly those living in rural areas and those with limited education and income. Children from culturally and linguistically diverse backgrounds are often not identified until entry into school. Also, given dwindling federal and state resources, many programs would be hard-pressed to add a new service without a new funding source.